Letters to the Editor - Dec. 13, 2004

Illinois State Medical Society a leader in barring physician participation in executions - Want a cheap, practical and universal EMR system? Ask for MOM - Physicians were once "captains of the ship" but now routinely face defiance

Illinois State Medical Society a leader in barring physician participation in executions

I read with interest your article, "In the execution chamber" (Article, Oct. 25). Illinois is a model state in the fight to remove physicians from the execution process.

Since the first widely publicized physician-assisted execution took place in Illinois in September 1990, the Illinois State Medical Society has led the way in protesting this unethical involvement by health care professionals. Our efforts were codified by the 2003 passage of a state law formally excluding health professionals from the Illinois execution statute and disallowing the shielding of unprofessional conduct from peer review. This Illinois law could serve as the model for legislation to get and keep physicians out of the execution chamber.

We hope that AMNews will continue to follow this important professional issue and keep physicians abreast on recent actions on this front.

--Kenneth J. Printen, MD, president, Illinois State Medical Society

Want a cheap, practical and universal EMR system? Ask for MOM

Much emotionally charged opinion continues to fly around the issue of the electronic medical record (or for those who love to dabble in obfuscation and stir the pot by constantly redefining terms, the electronic health record, EHR).

May I boldly state that there is only one way that we will ever see a universal EHR that is nationally portable and readily available at physician office, emergency room/hospital, pharmacy and monetary payer sites.

That solution is to have a single national entity (a computer system IT department -- lets call it ITD -- at the highest level of the Dept. of Health and Human Services) develop and maintain a basic software-integrated system we shall call MOM -- the Manager of Medicine.

MOM must be free to all physicians, pharmacies, hospitals and payers. MOM must be nonproprietary property of the U.S. government and will operate on a range of hardware systems. MOM will use the Internet, or its successors, to provide connectivity. MOM will handle payment of all government health services, which will ensure the universality of its use in a very short time.

And most important, the responsibility for maintaining MOM's operational readiness will rest on the shoulders of ITD, i.e., the single government agent responsible for its development, updating and performance.

Software support companies will still be able to offer services if needed by end users operating with MOM's free basic software. If MOM is structured as a Web service, software support companies would be able to provide other users with user-specific features without alterations in MOM.

MOM will have the following advantages:

MOM will provide an efficient, fully integrated electronic medical information system.
It will be affordable, since it is free to all users. Cost for users will be small beyond computer hardware and Internet access.
Operational responsibility rests in a single, identifiable entity (ITD).
Government mandates will be fulfilled by an agency of the government, not by the end user.

If you think such a solution won't work, let me assure you it does work already on a smaller scale. The Dept. of Defense has an evolving MOM that connects military facilities across the USA (and beyond) and even reaches into civilian pharmacies already. It surely isn't perfect, but the concept works because the organization mandating MOM's structure and capabilities is the same organization which must accomplish the mandate.

So I ask Congress to mandate the future of electronic health care. Then Congress should take on the responsibility to build MOM to meet that mandate. Please call me when MOM is ready to be installed on my G9 Mac.

--David W. Goetz, MD, Morgantown, W.Va.

Physicians were once "captains of the ship" but now routinely face defiance

Regarding "Staff less tolerant of rude doctors" (Article, Sept. 20): Your article is a disservice to the medical profession.

The physician is no longer captain of the ship, he is a prisoner on the ship. What evokes rudeness is very obvious. Decline in nursing and patient care, gross defiance of the physicians promoted by nonphysician executives and hospital board members.

The physician's life is run by HMOs, third-party payers, regulatory agencies, trial lawyers, licensing bodies, politicians and innumerable power seekers.

If nonphysician caregivers just do their jobs to the satisfaction of the patients and the physicians, we shall have a very harmonious, constructive relationship with all the stakeholders. Let us go back to the fundamentals -- physicians are the primary advocates for the patients and the public. This sacred right of the physicians is being usurped by nonphysicians.

We have an obligation to see that the physician-captain of the ship is not shackled to the detriment of the patients.

--Bipin N. Bhayani, MD, Kankakee, Ill.